Unison Kids is pleased to provide this formulary (preferred drug list or PDL) to be used when prescribing for patients covered by the pharmacy benefit plan of Unison Kids. This is a restricted formulary and only those drugs listed in this formulary will be covered by Unison Kids. The drugs listed in this formulary are intended to provide sufficient options to treat patients who require treatment with a drug from that pharmacologic or therapeutic class. The drugs listed in the Unison Kids formulary have been reviewed and approved by the Unison Kids and Therapeutics Committee. The drugs have been selected to provide the most clinically appropriate and cost-effective medications for patients who have their drug benefit administered through Unison Kids. It is also recognized there may be occasions where an unlisted drug is desired for proper medical management of a specific patient. In those infrequent instances, the unlisted medication may be requested through the Medical Exception process.

Please click below to be directed to our pharmacy formulary (preferred drug list or PDL).

• Preferred Drug List
• Searchable Drug List 

PDL Updates

• Pharmacy Network Plan Payer Sheet - Prescription Solutions
• Pennsylvania PDL Updates
• Synagis Provider Bulletin

Prior Authorization and Medical Exception Forms

• General Prior Authorization Form
• Prior Authorization Request Form for Aranesp/Epogen/Procrit
• Prior Authorization Request Form for TZDs and DPP-4s Products
• Prior Authorization Request Form for Growth Hormones
• Prior Authorization Request Form for Suboxone/Subutex
• Medical Exception Request Form for Synagis
• Prior Authorization Request Form for 17-alpha hydroxyprogesterone
• Prior Authorization Request Form for PPI
• Prior Authorization Request Form for Lupron
• Prior Authorization Request Form for Singulair
• Prior Authorization Request Form for Testosterone
• Prior Authorization Request Form for Celebrex
• Prior Authorization Request Form for Zetia
• Prior Authorization Request Form for Long-Acting Opiates

Important Step Therapy Information

• Step Therapy Program

Quality Initiatives

• Quantity Limits 

Pharmacy and Therapeutics (P&T) Committee Meeting Minutes

• Third Quarter 2010
• Second Quarter 2010
• First Quarter 2010
• Fourth Quarter 2009 - Part 1 | Part 2
• Third Quarter 2009
• Second Quarter 2009
• April 2009 Interval Meeting Minutes
• First Quarter 2009
• Fourth Quarter 2008